brand to generic reference chartbrand to generic reference chart 3 compare to description 4/a ndc...

16
RUGBY Products FIBERCON ® FIBER-LAX POLYCARBOPHIL TABLETS FLEET ® ENEMA ENEMA DISPOSABLE FLINTSTONES ® CHEWABLE-VITE TABLETS FLINTSTONES ® PLUS IRON CHEWABLE-VITE W/IRON TABLETS LACTAID ® LAC-DOSE ® CAPTABS LIQUIFILM ® TEARS ARTIFICIAL TEARS SOLUTION STERILE MAALOX ® ADVANCED REG. STRENGTH RULOX ANTACID SUSP-MINT FLAVOR MEGA RED ® KRILL OIL SOFTGEL CAPS METAMUCIL ® REGULOID ® CAPSULES & POWDER MINERAL ICE ® BLUE GEL/MUSCULAR PAIN RELIEF MYLANTA ® ALMACONE ® ANTACID LIQUID MYLANTA ® DOUBLE STRENGTH ALMACONE ® DOUBLE STRENGTH ANTACID MYLANTA ® GAS SIMETHICONE GAS RELIEF TABLETS MYLANTA ® GAS MAX STR SIMETHICONE MAX STR GAS RELIEF TABLETS MYLICON ® SIMETHICONE GAS RELIEF DROPS NEO-CALGLUCON ® CALCIONATE SYRUP NICORETTE ® GUM NICOTINE POLACRILEX GUM OCEAN ® NASAL MIST SALINE MIST OCUVITE ® I-VITE TABLETS OCUVITE ® PRESERVISION ® I-VITE PROTECT TABLETS ONE-A-DAY ® ESSENTIAL DAILY-VITE TABLETS OS-CAL ® 250+D TABS OYSCO ® D TABLETS OS-CAL ® 500 OYSCO ® 500 TABLETS OS-CAL ® CHEWABLE OYSCO ® 500+D CHEW TABS OS-CAL ® 500+D OYSCO ® 500+D TABLETS OXY BALANCE ® BENZOYL PEROX/ACNE MED 5% GEL OXY-10 BALANCE ® BENZOYL PEROX/ACNE MED 10% GEL PEDIALYTE ® ORALYTE ® SOLUTION & FREEZER POPS PEPTO-BISMOL ® PEPTIC RELIEF CHEW TABLETS PERCOGESIC ® ACETA-GESIC ® PAIN TABLETS PERI-COLACE ® DOC SOD & SENNA TABLETS PHAZYME ® SIMETHICONE GAS RELIEF SOFTGELS PHILLIPS’ ® MILK OF MAGNESIA BRAND TO GENERIC REFERENCE CHART 2 COMPARE TO DESCRIPTION RUGBY Products POLY-VI-SOL ® POLY VITAMIN CHEW TABLETS & DROPS POLY-VI-SOL ® WITH IRON POLY VITAMIN W/IRON CHEW TABS & DROPS PREVACID ® 24HR LANSOPRAZOLE DR CAPSULES ROBITUSSIN ® GUAIFENESIN COUGH SYRUP ROBITUSSIN ® DM GUAIFENESIN DM EXTRA ACTN COUGH SYRUP SEBULEX ® SEBEX SHAMPOO SELSUN BLUE ® SELENIUM SULF/ANTI-DANDRUFF SHAMPOO SENOKOT ® SENEXON ® NATURAL VEG LAXATIVE LIQUID & TABS SENOKOT-S ® SENEXON ® -S NATURAL VEG LAXATIVE TABS SLOW FE ® FERROUS SULFATE ER TABLETS STRESSTABS ® VI-STRESS TABLETS STUART PRENATAL ® PRENAVITE ® TABLETS FC SUDAFED ® PSEUDOEPHEDRINE/NASAL DECON TABLETS SURFAK ® DOC CAL/STL SOFT-DC SGEL CAPS TEARS NATURALE ® NATURE’S TEARS THERAGRAN ® THEREMS ® FILM COATED TABLETS THERAGRAN-M ® ADV THEREMS ® -M FILM COATED TABLETS TINACTIN ® TOLNAFTATE 1% ANTIFUNGAL POWDER TRIPLE FLEX ® GLUCOSAMINE, CHONDROITIN AND MSM TRI-VI-SOL ® TRI-VITAMIN DROPS TUMS ® CAL-GEST ® ANTACID CHEW TABLETS TYLENOL ® APAP PAIN/FEVER TABLETS TYLENOL ® , CHILDREN’S APAP PAIN/FEVER CHILDREN’S CHEW TABS TYLENOL ® , CHILDREN’S APAP PAIN/FEVER ORAL SOLUTION TYLENOL ® EXTRA STR APAP PAIN/FEVER X-STR TABLETS/CAPTABS TYLENOL ® INFANTS’ DROPS APAP PAIN/FEVER CONCENTRATED DROPS TYLENOL ® INFANTS’ ORAL SUSP APAP PAIN/FEVER CHILDREN’S ORAL SUSP TYLENOL ® PM APAP/DIPH CAPTABS UNICAP-M ® UNICOMPLEX-M TABLETS VISINE ® TETRAHYDROZOLINE/EYE DROPS Z-BEC ® BEE-ZEE TABLETS ZOSTRIX ® CAPSAICIN 0.025% CREAM ZYRTEC ® CETIRIZINE HCL TABLETS BRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION

Upload: others

Post on 27-Mar-2020

47 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

RUGBY Products

FIBERCON® FIBER-LAX POLYCARBOPHIL TABLETS

FLEET® ENEMA ENEMA DISPOSABLE

FLINTSTONES® CHEWABLE-VITE TABLETS

FLINTSTONES® PLUS IRON CHEWABLE-VITE W/IRON TABLETS

LACTAID® LAC-DOSE® CAPTABS

LIQUIFILM® TEARS ARTIFICIAL TEARS SOLUTION STERILE

MAALOX® ADVANCED REG. STRENGTH RULOX ANTACID SUSP-MINT FLAVOR

MEGA RED® KRILL OIL SOFTGEL CAPS

METAMUCIL® REGULOID® CAPSULES & POWDER

MINERAL ICE® BLUE GEL/MUSCULAR PAIN RELIEF

MYLANTA® ALMACONE® ANTACID LIQUID

MYLANTA® DOUBLE STRENGTH ALMACONE® DOUBLE STRENGTH ANTACID

MYLANTA® GAS SIMETHICONE GAS RELIEF TABLETS

MYLANTA® GAS MAX STR SIMETHICONE MAX STR GAS RELIEF TABLETS

MYLICON® SIMETHICONE GAS RELIEF DROPS

NEO-CALGLUCON® CALCIONATE SYRUP

NICORETTE® GUM NICOTINE POLACRILEX GUM

OCEAN® NASAL MIST SALINE MIST

OCUVITE® I-VITE TABLETS

OCUVITE® PRESERVISION® I-VITE PROTECT TABLETS

ONE-A-DAY® ESSENTIAL DAILY-VITE TABLETS

OS-CAL® 250+D TABS OYSCO® D TABLETS

OS-CAL® 500 OYSCO® 500 TABLETS

OS-CAL® CHEWABLE OYSCO® 500+D CHEW TABS

OS-CAL® 500+D OYSCO® 500+D TABLETS

OXY BALANCE® BENZOYL PEROX/ACNE MED 5% GEL

OXY-10 BALANCE® BENZOYL PEROX/ACNE MED 10% GEL

PEDIALYTE® ORALYTE® SOLUTION & FREEZER POPS

PEPTO-BISMOL® PEPTIC RELIEF CHEW TABLETS

PERCOGESIC® ACETA-GESIC® PAIN TABLETS

PERI-COLACE® DOC SOD & SENNA TABLETS

PHAZYME® SIMETHICONE GAS RELIEF SOFTGELS

PHILLIPS’® MILK OF MAGNESIA

BRAND TO GENERIC REFERENCE CHART

2

COMPARE TO DESCRIPTION

RUGBY Products

POLY-VI-SOL® POLY VITAMIN CHEW TABLETS & DROPS

POLY-VI-SOL® WITH IRON POLY VITAMIN W/IRON CHEW TABS & DROPS

PREVACID®24HR LANSOPRAZOLE DR CAPSULES

ROBITUSSIN® GUAIFENESIN COUGH SYRUP

ROBITUSSIN® DM GUAIFENESIN DM EXTRA ACTN COUGH SYRUP

SEBULEX® SEBEX SHAMPOO

SELSUN BLUE® SELENIUM SULF/ANTI-DANDRUFF SHAMPOO

SENOKOT® SENEXON® NATURAL VEG LAXATIVE LIQUID & TABS

SENOKOT-S® SENEXON®-S NATURAL VEG LAXATIVE TABS

SLOW FE® FERROUS SULFATE ER TABLETS

STRESSTABS® VI-STRESS TABLETS

STUART PRENATAL® PRENAVITE® TABLETS FC

SUDAFED® PSEUDOEPHEDRINE/NASAL DECON TABLETS

SURFAK® DOC CAL/STL SOFT-DC SGEL CAPS

TEARS NATURALE® NATURE’S TEARS

THERAGRAN® THEREMS® FILM COATED TABLETS

THERAGRAN-M® ADV THEREMS®-M FILM COATED TABLETS

TINACTIN® TOLNAFTATE 1% ANTIFUNGAL POWDER

TRIPLE FLEX® GLUCOSAMINE, CHONDROITIN AND MSM

TRI-VI-SOL® TRI-VITAMIN DROPS

TUMS® CAL-GEST® ANTACID CHEW TABLETS

TYLENOL® APAP PAIN/FEVER TABLETS

TYLENOL®, CHILDREN’S APAP PAIN/FEVER CHILDREN’S CHEW TABS

TYLENOL®, CHILDREN’S APAP PAIN/FEVER ORAL SOLUTION

TYLENOL® EXTRA STR APAP PAIN/FEVER X-STR TABLETS/CAPTABS

TYLENOL® INFANTS’ DROPS APAP PAIN/FEVER CONCENTRATED DROPS

TYLENOL® INFANTS’ ORAL SUSP APAP PAIN/FEVER CHILDREN’S ORAL SUSP

TYLENOL® PM APAP/DIPH CAPTABS

UNICAP-M® UNICOMPLEX-M TABLETS

VISINE® TETRAHYDROZOLINE/EYE DROPS

Z-BEC® BEE-ZEE TABLETS

ZOSTRIX® CAPSAICIN 0.025% CREAM

ZYRTEC® CETIRIZINE HCL TABLETS

BRAND TO GENERIC REFERENCE CHART

3

COMPARE TO DESCRIPTION

Page 2: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

4/A

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

360501 ACETA-GESIC® PAIN TABLETS 100 PERCOGESIC® $2.40 305363605016

718001 ACIDOPHILUS CAPTABS® 100 $4.43 005367180013

718101 ACIDOPHILUS EXTRA STRENGTH CAPTABS® 100 $4.43 005367181010

750001 ALCOHOL PREPS STERILE PADS 100 $3.01 305367500010

037097 ALLER-CHLOR® SYRUP 4 OZ CHLOR-TRIMETON® $3.27 305360370979

346701 ALLER-CHLOR®/CPM 4 MG TABLETS 100 CHLOR-TRIMETON® $5.70 305363467010

346710 ALLER-CHLOR®/CPM 4 MG TABLETS 1000 CHLOR-TRIMETON® $17.17 305363467102

346735 ALLER-CHLOR®/CPM 4 MG TABLETS BL/PK 24 CHLOR-TRIMETON® $3.06 305363467355

002583 ALMACONE® ANTACID LIQUID 12 OZ MYLANTA® $3.10 305360025831

350401 ALMACONE® CHEW TABS MLT 100 $3.78 305363504012

001583 ALMACONE® DOUBLE STRENGTH ANTACID 12 OZMYLANTA®

$4.45 305360015832DOUBLE STRENGTH

009185 ALUMINUM HYDROXIDE GEL PT AMPHOJEL® $5.60 305360091850

558806 ANTIOXIDANT FORMULA SGEL CAPS 50 $5.40 005365588064

558908 ANTIOXIDANT ULTRA FORMULA SGEL CAPS 60 $13.43 005365589085

193672 APAP PAIN/FEVER 15 ML TYLENOL® INFANTS’ DROPS $3.15 305361936723CONCENTRATED DROPS

012285 APAP ORAL SOL PAIN/FEVER – CHERRY PT TYLENOL®, CHILDREN’S $8.25 305360122851

012297 APAP ORAL SOL PAIN/FEVER – CHERRY 4 OZ TYLENOL®, CHILDREN’S $3.78 305360122974

322201 APAP 325 MG PAIN/FEVER TABLETS 100 TYLENOL® $4.20 305363222015

322210 APAP 325 MG PAIN/FEVER TABLETS 1000 TYLENOL® $22.42 305363222107

323307 APAP 80 MG PAIN/FEVER 30 TYLENOL®, CHILDREN’S $2.63 305363233073CHILD’S CHEWTABS – FRUIT

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

NO.

1

5

9

13

17

2

6

10

14

18

3

7

11

15

19

4

8

12

16

20

Page 3: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

21

25

29

33

37

22

26

30

34

38

23

27

31

35

39

24

28

32

36

40

360696 APAP 160 MG PAIN/FEVER 2 OZ INFANTS’ TYLENOL® $3.94 305363606969CHILD’S ORAL SUSP-CHERRY

321801 APAP 500 MG PAIN/FEVER X-STR CAPTABS 100 TYLENOL® EXTRA STR $5.10 305363218018

321810 APAP 500 MG PAIN/FEVER X-STR CAPTABS 1000 TYLENOL® EXTRA STR $29.93 305363218100

323101 APAP 500 MG PAIN/FEVER X-STR TABLETS 100 TYLENOL® EXTRA STR $4.72 305363231017

323110 APAP 500 MG PAIN/FEVER X-STR TABLETS 1000 TYLENOL® EXTRA STR $29.85 305363231109

347906 APAP 500 MG/DIPH 25 MG CAPTABS 50 TYLENOL® PM $5.27 305363479068

655091 ARTIFICIAL TEARS OPHTH OINTMENT 1 DZ $44.39 305366550917

197072 ARTIFICIAL TEARS SOLUTION STERILE 15 ML LIQUIFILM® TEARS $4.38 305361970727

329736 ASPIRIN 1 1/4 GR CHEW TABLETS 36 BAYER® CHILDREN’S $2.25 305363297365

308610 ASPIRIN 81 MG EC TABLETS 1000 BAYER®, ASPIRIN REGIMEN$45.66 305363086105

308641 ASPIRIN 81 MG EC TABLETS 120 BAYER®, ASPIRIN REGIMEN $5.48 305363086419

331301 ASPIRIN 325 MG TABLETS EC ORANGE 100 ECOTRIN® $4.20 305363313010

331310 ASPIRIN 325 MG TABLETS EC ORANGE 1000 ECOTRIN® $26.55 305363313102

330501 ASPIRIN 325 MG TABLETS 100 BAYER®, GENUINE $3.45 305363305015MICRO-COATED WHITE

330510ASPIRIN 325 MG TABLETS

1000 BAYER®, GENUINE $20.25 305363305107MICRO-COATED WHITE

335708 BEE-ZEE TABLETS 60 Z-BEC® $5.25 005363357082

409256 BENZOYL PEROX GEL/ACNE MED 10% TB OXY-10 BALANCE® $6.91 305364092563

408956 BENZOYL PEROX GEL/ACNE MED 5% TB OXY BALANCE® $5.68 305364089563

081595 BENZOYL PEROX LOTION/ACNE MED 10% 1 OZ $3.45 305360815951

081095 BENZOYL PEROX LOTION/ACNE MED 5% 1 OZ $3.02 305360810956

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

6/A-B

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.NDC

DESCRIPTION SIZE COMPARE

SWPUPC

00536- TO CODE

Page 4: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

41

45

49

53

57

42

46

50

54

58

43

47

51

55

59

44

48

52

56

60

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

8/B-C

490201 BETA CAROTENE 25,000 IU SGEL CAPS 100 $6.00 005364902014

665901 BIOTIN 300 MCG TABLETS 100 $3.74 005366659015

230259 BLUE GEL /MUSCULAR PAIN RELIEF 8 OZ MINERAL ICE® $3.97 305362302596

379201 CALCI-CHEW CHERRY 100 $11.66 005363792012

379101 CALCI-MIX 100 $13.71 005363791015

277085 CALCIONATE SYRUP PT NEO-CALGLUCON® $19.73 005362770851

342608 CALCIUM 600 TABLETS 60 CALTRATE® 600 $4.79 005363426085

342408 CALCIUM 600-D TABLETS 60 CALTRATE® 600 + D $4.79 005363424081

341410 CALCIUM CARBONATE 10 GR TABLETS 1000 $15.75 305363414106

688908 CALCIUM 500 MG CHEW TABLETS 60 $4.35 005366889085

341610 CALCIUM GLUCONATE 10 GR TABLETS 1000 $17.32 005363416109

342201 CALCIUM LACTATE 10 GR TABLETS 100 $3.46 005363422018

342210 CALCIUM LACTATE 10 GR TABLETS 1000 $18.15 005363422100

474297 CAL-GEST® ANTACID CHEW TABLETS 150 TUMS® $4.13 305364742970

252525 CAPSAICIN 0.025% CREAM 60 GM ZOSTRIX® $9.95 305362525254

344238 CEROVITE® TABLETS ADVANCED FORMULA 130 CENTRUM® $6.45 005363442382

344308 CEROVITE® JR. CHEW TABLETS 60 CENTRUM KIDS® COMPLETE $3.82 005363443082

279059 CEROVITE® LIQUID 8 OZ CENTRUM® LIQUID $5.40 005362790590

344508 CEROVITE® SENIOR TABLETS 60 CENTRUM® SILVER® $4.65 005363445086

408888 CETIRIZINE HCL 10 MG TABLETS 14 ZYRTEC® $3.69 305364088887

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 5: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

61

65

69

73

77

62

66

70

74

78

63

67

71

75

79

64

68

72

76

80

408807 CETIRIZINE HCL 10 MG TABLETS 30 ZYRTEC® $4.60 305364088078

408811 CETIRIZINE HCL 10 MG TABLETS 90 ZYRTEC® $10.43 305364088115

344801 CHEWABLE VITE TABLETS 100 FLINTSTONES® $5.25 005363448018

344901 CHEWABLE VITE W/IRON TABLETS 100 FLINTSTONES® PLUS IRON $5.47 005363449015

345101 CHLOROPHYLL TABLETS 100 $2.78 005363451018

666808 CHROMIUM (PICOLINATE) 200 MCG 60 $7.43 005366668086SGEL CAPS

322408 CITRUS CALCIUM + D TABLETS 60 CITRACAL® MAXIMUM $5.10 005363224087

322301 CITRUS CALCIUM W/VITAMIN D TABLETS 100 CITRACAL® PETITES $5.10 005363223011

638401 COD LIVER OIL SGEL CAPS 100 $3.30 005366384016

193807 COENZYME Q10 100 MG SGEL CAPS 30 $14.85 005361938078

203007 COENZYME Q10 200 MG SGEL CAPS 30 $17.34 005362030078

999512 CONDOMS PREM. LUBRICATED (BOX 12) 1 $3.78 305369995128

354701 DAILY-VITE TABLETS 100 ONE-A-DAY® ESSENTIAL $4.19 005363547018

354710 DAILY-VITE TABLETS 1000 ONE-A-DAY® ESSENTIAL $20.92 005363547100

354601 DAILY-VITE TABLETS W/IRON 100 $3.52 005363546011

354610 DAILY-VITE TABLETS W/IRON 1000 $20.92 005363546103

059085 DIOCTO LIQUID PT COLACE® LIQUID $12.00 305360590858

060085 DIOCTO SYRUP PT COLACE® $5.70 305360600854

359701 DIPHENHIST® 25 MG CAPTABS 100 BENADRYL® ALLERGY $6.38 305363597014

359401 DIPHENHIST® 25 MG BANDED CAPSULES 100 BENADRYL® ALLERGY $6.38 305363594013

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

10/C-D

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 6: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

81

85

89

93

97

82

86

90

94

98

83

87

91

95

99

84

88

92

96

100

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

12/D-F

077097 DIPHENHIST® ORAL SOLUTION BOXED 4 OZ BENADRYL® ALLERGY LIQ $3.78 305360770977

077085 DIPHENHIST® ORAL SOLUTION PT BENADRYL® ALLERGY LIQ $7.42 305360770854

377206 DIPHENHYDRAMINE HCL 50 MG TABLETS 50 COMPOZ® $4.43 305363772060

375501 DOC CAL/STL SOFT-DC 240 MG SGEL CAPS 100 SURFAK® $9.14 305363755018

375510 DOC CAL/STL SOFT-DC 240 MG SGEL CAPS 1000 SURFAK® $77.48 305363755100

375505 DOC CAL/STL SOFT-DC 240 MG SGEL CAPS 500 SURFAK® $40.91 305363755056

375701 DOC SOD/STL SOFT 250 MG X-STR SGEL CAPS 100 $6.57 305363757012

375710 DOC SOD/STL SOFT 250 MG X-STR SGEL CAPS 1000 $40.83 305363757104

375601 DOC SOD/STL SOFT 100 MG –RED SGEL CAPS 100 COLACE® $5.92 305363756015

375610 DOC SOD/STL SOFT 100 MG –RED SGEL CAPS 1000 COLACE® $32.40 305363756107

035510 DOCUSATE SODIUM 50 MG & 1000 PERI-COLACE® $31.95 305360355105SENNA 8.6 MG TABS

035501 DOCUSATE SODIUM 50 MG & 100 PERI-COLACE® $4.95 305360355013SENNA 8.6 MG TABS

300094 EARWAX TREATMENT DROPS 15 ML DEBROX® $2.54 305363000941

741551 ENEMA DISPOSABLE 4.5 OZ FLEET® ENEMA $0.79 305367415512

090197 EYE IRRIGATING SOLUTION 4 OZ $4.12 305360901975

589001 FERROUS SULFATE 325 MG 100 $4.04 005365890013(5 GR) FC RED TABLETS

071080 FER-IRON DROPS 50 ML FER-IN-SOL® DROPS $5.24 005360710804

065085 FERROUS SULFATE ELIXIR PT FEOSOL® ELIXIR $5.93 005360650858

348107 FERROUS SULFATE ER 140 MG TABLETS 30 SLOW FE® $5.81 005363481077

348108 FERROUS SULFATE ER 140 MG TABLETS 60 SLOW FE® $9.90 005363481084

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 7: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

101

105

109

113

117

102

106

110

114

118

103

107

111

115

119

104

108

112

116

120

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

14/F-I

430605 FIBER-LAX POLYCARBOPHIL 500 MG TABLETS 500 FIBERCON® $44.62 305364306059

430608 FIBER-LAX POLYCARBOPHIL 500 MG TABLETS 60 FIBERCON® $6.59 305364306080

430611 FIBER-LAX POLYCARBOPHIL 500 MG TABLETS 90 FIBERCON® $11.24 305364306110

384401 FOLIC ACID 400 MCG TABLETS 100 $2.10 005363844018

384301 FOLIC ACID 800 MCG TABLETS 100 $2.40 005363843011

311108 GLUCOSAMINE, CHONDROITIN AND MSM 60 TRIPLE FLEX® $12.76 005363111080

082597 GUAIFENESIN COUGH SYRUP BOXED 4 OZ ROBITUSSIN® $2.79 305360825974

082585 GUAIFENESIN COUGH SYRUP PT ROBITUSSIN® $4.94 305360825851

097085 GUAIFENESIN DM EXTRA ACTN COUGH SYRUP PT ROBITUSSIN® DM $8.09 305360970858

097097 GUAIFENESIN DM EXTRA ACTN COUGH SYRUP 4 OZ ROBITUSSIN® DM $3.27 305360970971

138912 HEMORRHOIDAL SUPPOSITORIES 12 $3.30 305361389123

510895 HYDROCORTISONE 1% CREAM/HYDROSKIN® 1 OZ CORTIZONE-10® $2.85 305365108959

510597 HYDROCORTISONE 1% LOTION/HYDROSKIN® 4 OZ $8.09 305365105972

360330 IBUPROFEN 200 MG SOFTGEL CAPSULES 80 ADVIL® LIQUI-GELS® $6.32 305363603302

358701 IBUPROFEN 200 MG TAB BROWN ROUND 100 ADVIL® $4.67 305363587015

358710 IBUPROFEN 200 MG TAB BROWN ROUND 1000 ADVIL® $46.83 305363587107

358702 IBUPROFEN 200 MG TAB BROWN ROUND 250 ADVIL® $9.33 305363587022

358706 IBUPROFEN 200 MG TAB BROWN ROUND 50 ADVIL® $2.92 305363587060

398401 INOSITOL 500 MG TABLETS 100 $8.24 005363984011

509008 I-VITE TABLETS 60 OCUVITE® $4.64 005365090086

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 8: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

121

129

133

137

122

126

130

134

138

123

127

131

135

139

124

128

132

136

140

125

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

16/I-M

417841 I-VITE PROTECT TABLETS 120 OCUVITE® PRESERVISION® $10.31 005364178419

231097 KIDKARE COUGH & COLD LIQUID 4 OZ $3.15 305362310973

348008 KRILL OIL 300 MG SOFTGEL CAPS 60 MEGA RED® $21.55 005363480087

408706 LAC-DOSE® CAPTABS 50 LACTAID® $5.70 005364087063

412288 LANSOPRAZOLE DR 15 MG CAPS 14 PREVACID®24HR $9.64 305364122888

338101 LAXATIVE EC TABS/BISACODYL 5 MG 100 DULCOLAX® $7.41 305363381019

338110 LAXATIVE EC TABS/BISACODYL 5 MG 1000 DULCOLAX® $27.55 305363381101

135501 LAXATIVE SUPPOSITORIES/BISACODYL 10 MG 100 DULCOLAX® SUPP $15.75 305361355012

135512 LAXATIVE SUPPOSITORIES/BISACODYL 10 MG 12 DULCOLAX® SUPP $4.17 305361355128

741008 L-CARNITINE 250 MG CAPS 60 $37.99 005367410080

390808 LIPOGEN SGEL CAPS 60 $6.45 005363908086

673101 L-LYSINE 500 MG TABLETS 100 $3.52 005366731018

704906 L-TYROSINE 500 MG CAPTABS® 50 $6.30 005367049068

668001 MAGNESIUM 27 MG CHELATED TABLETS 100 $3.37 005366680019

352141 MAGNESIUM OXIDE 400 MG TABLETS 120 $8.25 005363521414

398501 MECLIZINE HCL 12.5 MG TABLETS 100 $4.72 305363985019

398510 MECLIZINE HCL 12.5 MG TABLETS 1000 $42.48 305363985101

399001 MECLIZINE HCL 25 MG CHEW TABLETS 100 BONINE® $4.80 305363990013

399010 MECLIZINE HCL 25 MG CHEW TABLETS 1000 BONINE® $43.20 305363990105

641208 MELATONIN 3 MG TABLETS 60 $12.95 005366412085

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 9: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

141

145

149

153

157

142

146

150

154

158

143

147

151

155

159

144

148

152

160

156

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

18/M-N

247083 MILK OF MAGNESIA 12 OZ PHILLIPS’® $2.92 305362470837

247085 MILK OF MAGNESIA PT PHILLIPS’® $3.60 305362470851

404401 MULTILEX TABLETS 100 $5.70 005364044011

406001 MULTILEX T&M TABLETS 100 $6.83 005364060011

404610 MULTIVITAMINS TABLETS (8 VITAMINS) 1000 $19.12 005364046107

411306 NAPROXEN SODIUM 220 MG CAPTABS 50 ALEVE® $4.53 305364113060

623772 NATURE’S TEARS 15 ML TEARS NATURALE® $4.35 305366237726

730001 NEPHRO-VITE® TABLETS 100 $16.54 005367300015

407601 NIACIN 100 MG TABLETS (NICOTINIC) 100 $2.55 005364076012

407610 NIACIN 100 MG TABLETS (NICOTINIC) 1000 $21.39 005364076104

407810 NIACIN 500 MG TABLETS (NICOTINIC) 1000 $27.50 005364078108

407001 NIACIN 50 MG TABLETS (NICOTINIC) 100 $2.10 005364070010

407401 NIACIN 250 MG ER CAPSULES (NICOTINIC) 100 $8.42 005364074018

407701 NIACIN 500 MG ER CAPSULES (NICOTINIC) 100 $11.21 005364077019

703801 NIACIN 1000 MG TR CAPTABS® (NICOTINIC) 100 $8.25 005367038017

703001 NIACIN 500 MG TR TABLETS (NICOTINIC) 100 $6.30 005367030011

703301 NIACIN 750 MG TR TABLETS (NICOTINIC) 100 $7.42 005367033012

406801 NIACINAMIDE 100 MG TABLETS 100 $2.40 005364068017

406901 NIACINAMIDE 500 MG TABLETS 100 $3.45 005364069014

136234 NICOTINE GUM 2 MG MINT 20 NICORETTE® GUM $11.99 305361362348

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 10: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

161

162

163

164

165

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

20/N

136206 NICOTINE GUM 2 MG MINT 50 NICORETTE® GUM $21.36 305361362065

137234 NICOTINE GUM 4 MG MINT 20 NICORETTE® GUM $13.32 305361372347

137206 NICOTINE GUM 4 MG MINT 50 NICORETTE® GUM $25.81 305361372064

136223 NICOTINE GUM 2 MG MINT 110 NICORETTE® GUM $30.98 305361362232

137223 NICOTINE GUM 4 MG MINT 110 NICORETTE® GUM $41.96 305361372231

302934 NICOTINE GUM 2 MG ORIGINAL 20 NICORETTE® GUM $11.99 305363029348

302906 NICOTINE GUM 2 MG ORIGINAL 50 NICORETTE® GUM $21.36 305363029065

302923 NICOTINE GUM 2 MG ORIGINAL 110 NICORETTE® GUM $30.98 305363029232

303006 NICOTINE GUM 4 MG ORIGINAL 50 NICORETTE® GUM $25.81 305363030061

303023 NICOTINE GUM 4 MG ORIGINAL 110 NICORETTE® GUM $41.96 305363030238

340437 NICOTINE GUM 2 MG COATED CINNAMON 40NICORETTE® CINNAMONSURGE™ COATED GUM

$23.40 305363404374

340401 NICOTINE GUM 2 MG COATED CINNAMON 100 NICORETTE® CINNAMONSURGE™ COATED GUM

$39.50 305363404015

340537 NICOTINE GUM 4 MG COATED CINNAMON 40 NICORETTE® CINNAMONSURGE™ COATED GUM

$24.63 305363405371

340501 NICOTINE GUM 4 MG COATED CINNAMON 100 NICORETTE® CINNAMONSURGE™ COATED GUM

$41.58 305363405012

338637 NICOTINE GUM 2 MG COATED FRUIT 40 NICORETTE® FRUIT CHILL™COATED GUM

$23.40 305363386373

338601 NICOTINE GUM 2 MG COATED FRUIT 100 NICORETTE® FRUIT CHILL™COATED GUM

$39.50 305363386014

338737 NICOTINE GUM 4 MG COATED FRUIT 40 NICORETTE® FRUIT CHILL™$24.63 305363387370COATED GUM

338701 NICOTINE GUM 4 MG COATED FRUIT 100 NICORETTE® FRUIT CHILL™$41.58 305363387011COATED GUM

311237 NICOTINE GUM 2 MG COATED MINT 40 NICORETTE® FRESH MINT™$23.40 305363112378COATED GUM

311201 NICOTINE GUM 2 MG COATED MINT 100 NICORETTE® FRESH MINT™$39.50 305363112019COATED GUM

161

165

169

177

162

166

170

178

163

167

171

175

179

164

168

172

180

176174173

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 11: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

181

182

183

184

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

22/N-P

NO.

311337 NICOTINE GUM 4 MG COATED MINT 40 NICORETTE® FRESH MINT™$24.63 305363113375COATED GUM

311301 NICOTINE GUM 4 MG COATED MINT 100 NICORETTE® FRESH MINT™$41.58 305363113016COATED GUM

500572 NRS®-NASAL RELIEF SPRAY 15 ML AFRIN® SPRAY $3.38 305365005722

500575 NRS®-NASAL RELIEF SPRAY 30 ML AFRIN® SPRAY $4.42 305365005753

139517 ORALYTE® FREEZER POPS 16 PEDIALYTE® $6.58 305361395179

093686 ORALYTE® SOLUTION – BUBBLE GUM 33 OZ PEDIALYTE® $6.58 305360936861

093586 ORALYTE® SOLUTION – FRUIT 33 OZ PEDIALYTE® $6.58 305360935864

138586 ORALYTE® SOLUTION – GRAPE 33 OZ PEDIALYTE® $6.58 305361385866

000486 ORALYTE® SOLUTION – UNFLAVORED 33 OZ PEDIALYTE® $6.58 305360004867

781708 OYSCO® 500 + D TABLETS 60 OS-CAL® 500 + D $4.35 005367817087

781710 OYSCO® 500 + D TABLETS 1000 OS-CAL® 500 + D $14.49 005367817100

339908 OYSCO® 500 + D CHEW TABS 60 OS-CAL® CHEWABLE $5.67 005363399082

410602 OYSCO® 500 TABLETS 250 OS-CAL® 500 $13.42 005364106023

410608 OYSCO® 500 TABLETS 60 OS-CAL® 500 $4.35 005364106085

410301 OYSCO® D/CALCIUM SUPPLEMENT TABLETS 100 OS-CAL® 250 + D TABS $3.52 005364103015

410310 OYSCO® D/CALCIUM SUPPLEMENT TABLETS 1000 OS-CAL® 250 + D TABS $22.43 005364103107

410302 OYSCO® D/CALCIUM SUPPLEMENT TABLETS 250 OS-CAL® 250 + D TABS $7.95 005364103022

671701 PANTOTHENIC ACID 500 MG TABLETS 100 $5.62 005366717012

650601 PAPAYA ENZYME TABLETS 100 $2.90 005366506012

430107 PEPTIC RELIEF CHEW TABLETS 30 PEPTO-BISMOL® $2.93 305364301078

181

185

189

193

197

182

186

190

194

198

183

187

191

195

199

184

192

196

200

188

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 12: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

201

205

209

213

217

202

206

210

214

218

203

207

211

215

219

204

208

212

216

220

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

219

220

24/P-R

181059 PEPTIC RELIEF LIQUID 8 OZ $3.12 305361810597

242558 PHENASEPTIC THROAT SPRAY 6 OZ CHLORASEPTIC® $2.93 305362425585

430401 POLY VITAMIN CHEW TABLETS 100 POLY-VI-SOL® $4.43 005364304016

781601 POLY VITAMIN CHEW W/IRON TABS 100 POLY-VI-SOL® WITH IRON $4.65 005367816011

845080 POLY VITAMIN DROPS 50 ML POLY-VI-SOL® $5.24 005368450801

853080 POLY VITAMIN DROPS W/IRON 50 ML POLY-VI-SOL® WITH IRON $5.24 005368530800

408501 PRENAVITE® TABLETS FC 100 STUART PRENATAL® $6.21 005364085014

406301 PRENAVITE® TABLETS PROTEIN COATED 100 $6.21 005364063012

311607 PROBIOTIC FORMULA CAPSULES 30 $9.94 005363116078

185097 PSEUDOEPHEDRINE/NASAL DCON. 4 OZ $3.15 305361850975LIQUID BOX

185085 PSEUDOEPHEDRINE/NASAL DCON. LIQUID PT $7.42 305361850852

439135 PSEUDOEPHEDRINE/NASAL DCON. TABS BL/PK 24 SUDAFED® $2.47 305364391352

150060 REGULOID® CAPSULES 160 METAMUCIL® $9.70 305361500603

187579 REGULOID® S-FREE LAX POWDER ORANGE 10 OZ METAMUCIL® ORANGE $6.42 305361875794

187516 REGULOID® S-FREE LAX POWDER ORANGE 15 OZ METAMUCIL® ORANGE $7.96 305361875169

188179 REGULOID® S-FREE LAX POWDER REGULAR 10 OZ METAMUCIL® $6.42 305361881795

188116 REGULOID® S-FREE LAX POWDER REGULAR 15 OZ METAMUCIL® $7.96 305361881160

444554 REGULOID®/NAT VEGETABLE 13 OZ METAMUCIL® ORANGE $5.25 305364445543LAX POWDER ORANGE

444589 REGULOID®/NAT VEGETABLE 19 OZ METAMUCIL® ORANGE $7.42 305364445895LAX POWDER ORANGE

444454REGULOID®/NAT VEGETABLE

13 OZ METAMUCIL® $5.25 305364444546LAX POWDER REGULAR

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 13: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

221

225

229

233

237

222

226

230

234

238

223

227

231

235

239

224

228

232

236

240

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

221

222

223

224

225

226

227

228

229

230

231

232

233

234

235

236

237

238

239

240

26/R-S

444489 REGULOID®/NAT VEGETABLE 19 OZ METAMUCIL® $7.42 305364444898LAX POWDER REGULAR

194583 RULOX ANTACID SUSP-MINT FLAVOR 19 OZMAALOX® ADVANCED

$2.85 305361945831REG. STRENGTH

250676 SALINE MIST 45 ML OCEAN® NASAL MIST $2.32 005362506764

718601 SEA OMEGA® 30 SGEL CAPS 100 $6.75 005367186015

718706 SEA OMEGA® 50 SGEL CAPS 50 $7.07 005367187067

196297 SEBEX SHAMPOO 4 OZ SEBULEX® $4.43 305361962975

199553 SELENIUM SULF/ANTI-DANDRUFF SHAMPOO 7 OZ SELSUN BLUE® $4.57 305361995539

127559 SENEXON® LIQUID 8 OZ SENOKOT® $17.52 305361275594

590401 SENEXON® NATURAL VEG LAXATIVE TABS 100 SENOKOT® $4.77 305365904018

590410 SENEXON® NATURAL VEG LAXATIVE TABS 1000 SENOKOT® $27.75 305365904100

408601 SENEXON®-S 50/8.6 MG TABS 100 SENOKOT-S® $4.95 305364086012

408610 SENEXON®-S 50/8.6 MG TABS 1000 SENOKOT-S® $31.95 305364086104

453408 SIMETHICONE 125 MG GAS RELIEF TABLETS 60 MYLANTA® GAS MAX STR $5.02 305364534087

453301 SIMETHICONE 80 MG GAS RELIEF TABLETS 100 MYLANTA® GAS $6.30 305364533011

222075 SIMETHICONE/GAS RELIEF DROPS 30 ML MYLICON® $7.05 305362220753

360408 SIMETHICONE 180 MG GAS RELIEF SOFTGELS 60 PHAZYME® $3.05 305363604088

454410 SODIUM BICARBONATE 10 GR TABLETS 1000 $13.65 305364544109

454010 SODIUM BICARBONATE 5 GR TABLETS 1000 $11.55 305364540101

991601 SYRINGE INS 1/2 CC 28 G X 1/2 IN U100 100 $23.85 005369916016

991501 SYRINGE INS 1 CC 28 G X 1/2 IN U100 100 $23.85 005369915019

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 14: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

241

245

249

253

257

242

246

250

254

258

243

247

251

255

259

244

248

252

256

260

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

241

242

243

244

245

246

247

248

249

250

251

252

253

254

255

256

257

258

259

260

28/S-V

993001 SYRINGE INS 1CC 31 G X 5/16 IN U100 100 $16.55 005369930012

094094 TETRAHYDROZOLINE/EYE DROPS 15 ML VISINE® $2.10 305360940943

466010 THEREMS® FILM COATED TABLETS 1000 THERAGRAN® $36.83 005364660105

466038 THEREMS® FILM COATED TABLETS 130 THERAGRAN® $7.35 005364660389

466711 THEREMS®-H TABLETS 90 $8.50 005364667111

466110 THEREMS®-M FILM COATED TABLETS 1000 THERAGRAN-M® ADV $39.02 005364661102

466138 THEREMS®-M FILM COATED TABLETS 130 THERAGRAN-M® ADV $7.60 005364661386

515026 TOLNAFTATE 1% ANTIFUNGAL POWDER 45 GM TINACTIN® $3.37 305365150262

850180 TRI-VITAMIN DROPS 50 ML TRI-VI-SOL® $8.07 005368501800

475011 UNICOMPLEX-M TABLETS 90 UNICAP-M® $4.50 005364750110

475308 VI-STRESS TABLETS 60 STRESSTABS® $5.47 005364753081

478701 VIT B COMPLEX SGEL CAPS 100 $3.35 005364787017

355601 VIT B-12 1000 MCG TABLETS 100 $5.02 005363556010CYANOCOBALAMIN

354201VIT B-12 100 MCG TABLETS

100 $2.25 005363542013CYANOCOBALAMIN

355101 VIT B-12 500 MCG TABLETS 100 $3.60 005363551015CYANOCOBALAMIN

440601 VIT B-6 25 MG TABLETS PYRIDOX HCL 100 $3.44 005364406017

440901 VIT B-6 100 MG TABLETS PYRIDOX HCL 100 $3.30 005364409018

440801 VIT B-6 50 MG TABLETS PYRIDOX HCL 100 $3.89 005364408011

440810 VIT B-6 50 MG TABLETS PYRIDOX HCL 1000 $15.67 005364408103

468001 VIT B-1 100 MG TABLETS THIAMINE 100 $4.50 005364680011

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 15: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

262

266

263 264

NDCDESCRIPTION SIZE

COMPARESWP

UPC00536- TO CODE

261

262

263

264

265

266

267

268

269

270

271

272

273

274

275

276

30/V-Z

468010 VIT B-1 100 MG TABLETS THIAMINE 1000 $20.25 005364680103

467801 VIT B-1 50 MG TABLETS THIAMINE 100 $2.17 005364678018

329201 VIT C 500 MG TABLETS 100 $4.12 005363292017

329210 VIT C 500 MG TABLETS 1000 $29.25 005363292109

329101 VIT C 500 MG CHEW TABLETS 100 $5.47 005363291010

016097 VIT C 500 MG SYRUP 4 OZ $4.88 005360160975

016085 VIT C 500 MG SYRUP PT $14.25 005360160852

333401 VIT D 1000 IU TABLETS 100 $2.85 005363334014

379001 VIT D 2000 IU SGEL CAPS 100 $6.80 005363790018

479301 VIT E 100 IU SGEL CAPS 100 $3.78 005364793018

479901 VIT E 400 IU SGEL CAPS 100 $6.44 005364799010

476301 VITA-BEE W/C CAPTABS® 100 ALLBEE® WITH C $4.58 005364763011

718301 ZINC & C LOZENGES 100 $3.90 005367183014

667101 ZINC CHELATED 50 MG TABLETS 100 $2.85 005366671017

570098 ZINC OXIDE OINTMENT 1 LB $6.75 305365700986

245001 ZINC SULFATE 220 MG TABLETS 100 $7.50 005362450012

268267

270

261

269

265

271 272

274273 275 276

Prices subject to change without notice. Third-party trademarks are the property of their respective owners.

Medicaid reimbursable in most states.

NO.

Page 16: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS

32

Other Useful Phone Numbers Important Contact InformationNOTES